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JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY December 2017 • Volume 10 • Number 12
O R I G I N A L R E S E A R C H
noticeably.
17
This is mostly due to the effect of
cytokines and growth factors that influence
fibroblast activity early on in wound healing. On
the other hand, neither the age of the patient,
nor the scar site have been found to influence
the percentage of clinical improvement.
Haedersdal et al
18
found no differences in the
efficacy of treatment with respect to subject
age, anatomical location of the scar, or duration
of the scar. In treating different types of scar, El
Taweel and Abd El-Rahman found that clinical
improvement was better in younger patients.
19
Regarding side effects and complications, the
pain was generally tolerable.
Hyperpigmentation was observed in three
patients (17.6%), with skin type III. This was
mostly attributed to the close spacing and
non-adjuvant use of bleaching agents. El Taweel
and Abd El-Rahman
19
reported the development
of hyperpigmentation in three out of 25 patients
with mature scars (12%) treated by fractional
CO₂ laser. As in our cases, hyperpigmentation
improved with bleaching agents. In the current
study, one patient experienced a significant
lightening of her scar, which can be a
consequence of skin rejuvenation.
20
Actual
hypopigmentation developed in only two cases
(11.7%). In one patient, it was in the form of a
widening of an initially hypopigmented area,
which may have been attributed to deep
stacking causing thermal injury. The other case
developed hypopigmentation following early
removal of the crust by the patient. The
incidence of hypopigmentation in the current
study is much lower than that reported by Salles
et al.
21
Generally, the developed side effects did
not affect patients' satisfaction with the
achieved results as indicated by significant
reduction in POSAS patients' overall assessment
scores.
In conclusion, fractional CO₂ laser can be an
effective and safe modality in the treatment of
post-burn scars. It achieves significant change in
the opinion of the patients about their scar
appearance. Limitations of our study included
its small sample size and the relatively short
follow-up period. More sessions are needed to
reach the ultimate response. Wider spacing can
be used to avoid confluent thermal damage and
reduce side effects. The concomitant use of
bleaching creams can also reduce the incidence
of hyperpigmentation.
REFERENCES
1. Brusselaers N, Pirayesh A, Hoeksema H, et al. Burn
scar assessment: a systematic review of different
scar scales. J Surg Res. 2010; 164(1):e115–e123.
2. Tanzi EL, Alster TS. Single-pass carbon dioxide
versus multiple-pass Er:YAG laser skin resurfacing:
a comparison of postoperative wound healing and
side-effect rates. Dermatol Surg. 2003;
29(1):80–84.
3. Alexiades-Armenakas MR, Dover JS, Arndt KA. The
spectrum of laser skin resurfacing: nonablative,
fractional, and ablative laser resurfacing. J Am
Acad Dermatol. 2008; 58(5):719–737.
4. Waibel J, Beer K. Ablative fractional laser
resurfacing for the treatment of a third-degree
burn. J Drug Dermatol. 2009;8(3):294–297.
5. Sullivan T, Smith J, Kermode J, et al. Courtemanche
DJ. Rating the burn scar. J Burn Care Rehabil.
1990;11(3):256–260.
TABLE 9. Comparison of orcein stain grading score and
the mean area % of elastic fibers (orcein stain) before
and after treatment.
STAIN RANGE MEAN ± SD
Orcein stain grading score
Before treatment 2–5 3.71±1.26
After treatment 1–5 2.88± 1.31
p value* 0.001
Mean area % of elastic fibres (orcein stain)
Before treatment 0.17–3.65 1.41±0.97
After treatment 2.46–13.75 7.06±3.30
p value* <0.001
SD: standard deviation
*p value significant if <0.05.
FIGURE 6. Photomicrographs representing results of orcein staining for elastic fibers for the same case presented in Figure
4, before treatment (A) and after treatment (B). Elastic fibers were completely absent from the scar tissue before treatment
(Grade 5). Following treatment, elastic fibers started to appear as a combination of short fragmented and fibrillar fibers
(Grade 2) (Orcein stain, original magnification x 40).
A
B